Table 8

Factors Associated With Appropriate Selection of Early Invasive Strategy or Ischemia-Guided Strategy in Patients With NSTE-ACS

Immediate invasive (within 2 h)Refractory angina
Signs or symptoms of HF or new or worsening mitral regurgitation
Hemodynamic instability
Recurrent angina or ischemia at rest or with low-level activities despite intensive medical therapy
Sustained VT or VF
Ischemia-guided strategyLow-risk score (e.g., TIMI [0 or 1], GRACE [<109])
Low-risk Tn-negative female patients
Patient or clinician preference in the absence of high-risk features
Early invasive (within 24 h)None of the above, but GRACE risk score >140
Temporal change in Tn (Section 3.4)
New or presumably new ST depression
Delayed invasive (within 25−72 h)None of the above but diabetes mellitus
Renal insufficiency (GFR <60 mL/min/1.73 m2)
Reduced LV systolic function (EF <0.40)
Early postinfarction angina
PCI within 6 mo
Prior CABG
GRACE risk score 109–140; TIMI score ≥2

CABG indicates coronary artery bypass graft; EF, ejection fraction; GFR, glomerular filtration rate; GRACE, Global Registry of Acute Coronary Events; HF, heart failure; LV, left ventricular; NSTE-ACS, non–ST-elevation acute coronary syndrome; PCI, percutaneous coronary intervention; TIMI, Thrombolysis In Myocardial Infarction; Tn, troponin; VF, ventricular fibrillation; and VT, ventricular tachycardia.